February 25, 2005

<Moderator> Welcome to tonight's chat with Dr. Simpson. Chat starts at 4pm PST/7pm EST. Please type out your questions and hit enter. We will see them and present them to Dr Simpson at the time of chat in the order we receive them. Thank you!

<Moderator> Bo McCoy is here to talk about the upcoming ObesityHelp Event in Phoenix. Dr.Simpson will be here shortly. Please allow Bo some time to tell you about the event and what is in store for those attending. Bo....the floor is yours.

<Bo McCoy> While we are waiting for chat to begin, if anyone would like to ask questions about the PHX event this weekend I will be glad to answer your questions. The event is open to all pre and post-op members and their supporters. Events make a great place to ask questions and learn. They are also a lot of fun.

<CHIDE RIDER> Who will the speakers be at the event

<Bo McCoy> This event we have Dr. Simpson, local bariatric surgeon who will be lecturing and answering your questions. If you have never heard Dr. Simpson you are missing it - he is quite entertaining. He also gives great information about long-term care and he keeps you smiling with his funny jokes! Dr. Timothy Katzen, a plastic surgeon, will also be there to answer questions about post-gastric body contouring.

<Bo McCoy> Some of the other speakers for the event will be Sandra De Maas, a nutritional expert who will help us learn to eat long-term even after the weight loss is done! Motivational speakers such as Dr. Monica Ganz and myself. :-)

<CHIDE RIDER> Will there be social events planned for this event?

<Bo McCoy> There will be some after event stuff planned by local support groups CHIDE. However, this event is special...!!! There will be a fashion show for all during the event. CHIDE, what types of entertainment things would you like to see in events?

<CHIDE RIDER> I would like to see a good mix of education and classes and social times. That way we also get a chance to get to know each other and learn from each others journeys

<Bo McCoy> Point well taken, CHIDE

<Bo McCoy> The event begins at 9am, but you want to come early to get a good seat. We are expecting a FULL house tomorrow. Registration at the door is still accepted.

<CHIDE RIDER> Why are the prices getting higher and you're not even including social events?

<Bo McCoy> CHIDE, this is an obvious concern. Cost for events continue to rise, but I understand your desire to enjoy the event that you pay for. Could you suggest some types of fun stuff that you would like to see? I believe we have added value to our events by increasing the level of the education and sometimes that can be PRICELESS. If fun is what you're looking for then I recommend that you join us for the Alaska cruise or the national events!!! However, the regional events always surprise me as the locals always seem to plan auxiliary events with ours. Don't miss the chance to meet new people and make new friends. If you have any specific event-related questions, please feel free to ask.

<CHIDE RIDER> Well I went to the LA event and enjoyed the break out classes even though they were a little unorganized. I really loved the fashion show and the Halloween ball. I met so many people and made so many friends that have now become my support network. How can I survive as a post/op without finding those people that I need for support. ObesityHelp needs to provide a forum that fosters these relationships. I can't meet people when I sit in a lecture all day

<Bo McCoy> CHIDE, thanks for good and constructive words. I will certainly let leadership know that more fun stuff is being requested. Thanks for the feedback.

<Moderator> Welcome Dr. Simpson

<Dr.Simpson> Hello all. Sorry that I am late.

<Moderator> Bo, are you finished?

<Bo McCoy> Hello Dr. Simpson.Yes, I have finished.

<Moderator> Ok, we will start the chat.

<Dr.Simpson> That would be fine. Bo, did you have any more you wanted to say?

<Bo McCoy> No sir. I will just sit and wait to see if any event questions come in. I will be here for a few minutes as a lurker, just in case.

<a> I have to take protein shake or bar to get in required protein for the day, is this ok?

<Dr.Simpson> Protein shakes and bars are mostly not needed after weight loss surgery. You should be able to get your protein in with food. However, there are times when you need to supplement them but what you need to consider is this: If you do not get in enough protein, you will not feel well, not do well, not heal well, and have a bad attitude, as well as bad breath. The bad breath coming from ketosis -- which is not your friend... it means you are breaking down muscle, not just fat -- Atkins was a bit off, but now he is off in the wild blue yonder, the great steak house in the sky. Also, you can only absorb so much protein at a time, so if you try to get it all in at once, chances are most of the protein will end up in the toilet, which makes for expensive toilet water. So try to get your protein in with food, and not drink. Save the drinking for things like water, and if you have some fine wine then send that wine to me: Dr. Simpson, Arizona Bariatric Center.

<a> I can not tell when I am full, until it is to late and it comes back up, what to Do?

<Dr.Simpson> We do not like vomiting, although some do -- it is not a good thing to do. You need to learn to size up your food. You need to learn to register in your mind the portions that you eat instead of eating until you throw up. Portion control is one of the features of successful patients --- they know how much they can hold and they know when too much is too much. So learn to figure out what volume of food you can eat and DO NOT CHALLENGE IT. Some days you can eat more, but that is not license to do so.

<Patti> I want to have lap band surgery. My insurance will not cover it. What I'm worried about is if I were to have a complication - then I'm stuck with whatever that would cost added to the surgery. What do you think? I messed this up. Again, what if I have complications after my lap band surgery and I have no insurance to cover it. Very concerned.

<Dr.Simpson> If you have complications after anything and have no insurance to cover it then it is a problem. The advantage of a lap band is that there are few complications. The numbers are low and the complications they have are minor and easy to deal with. For example, if a port flips --- that is minor surgery, not major surgery. The idea is that you get the weight off, save money for a rainy day fund, and go for it.

<rouen> how would your view yourself compared to other surgeons?

<Dr.Simpson> I have to use a mirror to view myself, but I can see other surgeons straight out. Bariatric surgeons are all fairly similar in our approach to surgery. We have no variation. Where we differ is in the after care, and some of us emphasize it more than others. For patients who like to have surgery and no aftercare, I would not be the surgeon for them. There are plenty of surgeons who do that. Otherwise, comparisons are a bit silly -- all the surgery is the same, and when you find a surgeon you like, you stick with them, especially if you feel comfortable with them and don't mind their typos.

<joann> Dr. do you think 43 lbs in 3 months is really a very slow weight loss? I was 260 when i started

<Dr.Simpson> That is about 14 pounds a month, which is pretty good, and we like patients to lose at a steady pace. When you look at where you started you have lost almost 20 per cent of your excess body weight. If you weighed 500 lbs then your equivalent weight loss would have been double what you did, which is 86 lbs and everyone would be saying "great". So don't kick yourself.

<Edna> Is it common to have irritable bowel syndrome and still have bariaric surgery, also how often do you have to undo nissens fundoplication before you do the roux-en-y?

<Dr.Simpson> IBS is not a problem with surgery. We have a lot of patients with that and if you have a Nissen then it might need to be unwrapped or not, depending on where it is. It does mean a more complicated surgery but you should do just fine.

<rouen> how long have you been doing BS?

<Dr.Simpson> I have done BS all my life. Some say that I have done it so long that I am full of it. Oh, bariatric surgery. I have been doing this since 1991.

<joann> I hear if you get hungry it could mean you have a leak into your stomach.

<Dr.Simpson> It could also mean that you are hungry, and I guarantee you will be hungry at least three times a day. Leaks between the upper and lower pouch, for those who have a nontransected stomach, are manifested by hunger that is not satisfied by the small amount that fills a pouch. But that is a vague symptom, and there are a lot more.

<kathleen g> Dr. Simpson: I am one year out (open RNY) and am beginning to see my skin slip and slide into 'interesting' piles of modern art. Most significantly, my thighs look like pudding and my former arse has deposited itself into rather large saddlebags. Is it common to have all of this removed post-op, or is the panni-tummy tuck the reconstructive surgery most often approved. Thank you.

<Dr.Simpson> Well, you have given up the look of being well-rounded for the look of a Sharpei. So you are unique, and that is in vogue these days. After all, anyone can get a tattoo, and anyone can get something pierced but how many can have interesting skin folds without having gone through obesity and surgery???? So celebrate the look --- we should make it a new fashion statement and drive the plastic surgeons out of business. but, if you decide not to be on the cutting edge of fashion then you describe common looks of post op patients for which they begin a long romance with plastic surgeons and the nips and tucks will do you well.

<Cindy> Dr. Simpson... What advice do you have for someone who is 2.5 years postop and having MAJOR issues w/ regain? Do you think it's possible to ACTUALLY get to goal after this long? and lastly... would you consider doing a chat specifically for those that have issues w/ regain?

<Dr.Simpson> Cindy, not only do I think it is possible to get to goal, but we wrote a whole workbook about that very issue: the book is called "Getting to Goal and Staying There: Lessons Learned From Successful Patients." We have many patients who were out a number of years and have used this book. To get on track, or back on track, and to work their way back into their goal and to stay there. The workbook is only available from www.obesitydr.com but will be out in worldwide production (Amazon.com) in a few months.

<kathleen g> Dr. Simpson: Is it common for post-ops to have body image problems down the line? Although I have lost six dress sizes (twelve if you don't count by twos) I look the same to me. My mind can't wrap around the changes. Thanx.

<Dr.Simpson> Body image is a funny thing and it is something that can be done and undone easily. Ok, body image is tough, and you will always think of yourself as a fat person and let me tell you a story. I had a patient years ago who lost a lot of weight and moved to Seattle (where I had been from). He was in a bar with some people when they made fun of an obese person. They had no idea that he had lost over 200 lbs and he became furious. He told me that inside of him was a fat person waiting to get out and bust their smug smiles. Keep looking at yourself in the mirror, keep working on that. You will see that you are smaller and smaller and keep going to your goal until you see yourself there. Good luck. I still see myself with blonde hair but I am told it is gray.

<Kristin> how long do you have to be at a bmi over 40 before you qualilfy for surgery?

<Dr.Simpson> Everyone is different. Some insurance companies require you be there for five years and some simply need the requirement to be there where it is. So check with your insurance company and see. Good luck.

<chilli> Do you have to crush all your pills up

<Dr.Simpson> No --- if I do that then they will taste bad. Most pills get through just fine.

<Janet> does everyone experience that "window of misery" during the 3 to 6 months out period?

<Dr.Simpson> It depends on the surgery. For example, the lap bands have about five hours of misery and most of those are from the insurance company denying the surgery. The main thing is to get up, get active, and keep moving. The longer you sit around and be miserable, the worse it is. So work hard, walk a lot, don't take narcotics and enjoy the ride.

<Post RNY> I had surgery 9/2/04. I've lost 60lbs, which seems slow when compared to most. I don't feel that I'm doing too many wrong things. How can I just start the RAPID weight loss again in the interim? (I lost 30lbs my first month, but I have been slow since then.)

<Dr.Simpson> Sixty pounds in six months is more than you have lost before and it is unrealistic to expect that rate to continue. There are things you can do. First, start walking, and walk at least two miles a day with a goal of 15 minutes per mile. Second, make good food choices. Don't eat junk, don't skip meals, and avoid snacking.

<kathleen g> Dr. Simpson: Today's news is highlighting the impact sodium in packaged foods has on our health (early death). How does excess sodium affect post-oppies? The same, worse or none of the above? Thank you.

<Dr.Simpson> Could you pass the salt? It will effect you the same, so avoid pre packaged foods and learn to cook for yourself or get someone to cook for you. If you drink a lot of water, exercise, and eat well you should do just fine.

<brandy> hi doc im 2 mos out of TT and hernia repair and i have another lump in belly isnt it too soon to be hernias

<Dr.Simpson> It can be a hernia, and sounds like it is. Some people are more prone to them, and post op weight loss surgery patients fit right in that class because often they don't get enough protein in and other nutrients. So eat right, see your surgeon, take vitamins, and Santa will be nice to you.

<chilli> how long will I be out of work

<Dr.Simpson> Until the economy turns around, and we create more jobs in this country. It depends on the surgery that you are going to have. Depends on whether you have complications or not. If you have a lap band you would be out of work a week...with a DS, about three to four weeks...RNY, in between. It also depends on who you work for. If you work for yourself then you will be working while in the hospital. If you work for the government it will be six weeks.

<Stephanie W> I have been told by my surgeons NP that I will need a stent before surgery....please tell me what that entails. Thank you

<Dr.Simpson> I have no idea what they are talking about. There are stents for many things, but I can think of no reason why you would need one for wls.

<sjcgurl> Hi.. I'm 18 years old and want to know the risk factors of having a lap band put in

<Dr.Simpson> The risk factors are well outlined in the inamed website, www.inamed.com, or in my first book at www.obesitydr.com but are fairly straightforward. But since you do not enter bowel, they are substantially less than other procedures.

<Brenda Clark> Is it possible to not need plastic surgery after weight loss.

<Dr.Simpson> It is possible, kind of like the sisters I knew growing up. One sister had four kids and has not a stretch mark on her. The other had two and her abdomen looks like a roadmap of the turnpike. Everyone is different, and so some won't need plastic surgery and some will. Again, if you like the look, you may not need it.

<kristin> i have been morbidly obese for most of my life. I have been over wieght since i was in the second grade. having tried to get my doctors involved and having failed, i did things on my own. diets and nutritionists, gyms... nothing did it.

<Dr.Simpson> Well, that is a common story and the answer is weight loss surgery, after an evaluation. It is not uncommon, but surgery is a tool. If I ask you to dig a six foot by six foot hole with your hands it would take a long time with a lot of dirt but if I give you a pick and shovel you can do it easier. Still work, but the tool makes it far less likely to give up. Dieting is tough, and all of those excess calories take a long time and a lot of work to get rid of. Surgery is the tool that makes it easier to lose the weight and keep it off.

<jonie> I would like to know what kind of food can I eat after the surgery

<Dr.Simpson> You can eat all kinds of food after surgery. Depends on when, and depends on the surgery. If you are a vegetarian you cannot eat meat but otherwise, you will be able to eat a number of things. But some will be a little more difficult at first. We have a whole chapter or three devoted to this in our first book: Weight Loss Surgery: A Lighter Look At A Heavy Subject.

<a> What do you think of the new defibulator type device surgery that is coming out for weight lose ?

<Dr.Simpson> It has not proven to be stellar -- you have to change wires, change batteries, and average weight loss is not that great.

<tj r> what level of tiredness should i expect after surgery? How long should it last?

<Dr.Simpson> You can be tired for a while, sometimes several weeks, sometimes several months. It all depends on several features, such as how active you are, if you make good choices to eat and so forth. So, lots of stuff to do.

<regrets> Following gastric bypass surgery (open) I had an infection that lasted for one year. After consulting an infection specialist, it was determined to be a staff infection. The source was from stitches that did not dissolve. Why did this happen and is it common? Also, I have had 4 hernia surgeries and multiple vitamin deficiencies. I lost 125 pounds but still weigh 250. I can't seem to lose more and am "dieting" again. I am constantly having problems with anemia, b-12 and calcium,

<Dr.Simpson> Wow, that is an unfortunate story and things that can happen to patients following surgery - and those things do and can happen. Deficiencies can be overcome if you can absorb the vitamins, and sounds like iron and B12 are yours, which are common after RNY surgery as well as calcium. You will have to always work at weight loss. It is not something that is easy, which is why we wrote a book to help you get through that and to get to your goal. But iron deficiency, B 12, and calcium are common after RNY surgery and need to be monitored by a physician and worked with. So get those things under control -- to lose weight is simple: With your tool there are a lot of things you can do - make good choices, weigh weekly, etc.

<bridgetwv> where the intestine is joined to the stomach.....will it eventually grow there or will it always be held in place by stitches?

<Dr.Simpson> It grows in and stitches are less important after a few weeks.

<Trista> My biggest worries about having the lap Roux en Y surgery are the development of blood clots and the long-term effects of forced malnutrition on my body? I know that I need to take regular supplements to my diet, but what can I do to lower my risk of developing post-surgery blood clots?

<Dr.Simpson> Walk, walk, walk some more. When you don't want to walk, keep walking and when you think you have not walked enough, walk again. We have patients walk from the first day and we think the more they walk, the better they do. Did I mention walking?

<Peg> I had my DS 15 months ago with a revision 5 months ago due to excessive weight loss. I'm still having difficulty maintaining my weight. Any suggestions other than enzymes?

<Dr.Simpson> It is a struggle and can be a struggle, but if you are maintaining that is good. Enzymes can be increased and your stomach will begin to get larger. Keep in touch with your surgeon, but I suspect it will turn around.

<Melissa F.> Hi - I'm 6 weeks post-op and having trouble last two days with diarrhea and vomiting not associated w/food. Any advice?

<Dr.Simpson> See your doctor. There is a lot of flu going around -- ask Michael Jackson, he was in the pediatric ward recently.

<susan in tenn> i has roux en y gastric bypass, no complications, and returned to work in 3 weeks...i work in a sedentary field:) 4 weeks out of surgery as of this week :)

<Dr.Simpson> Congratulations, that is great -- and you need to begin a walking program. You need to make some good choices, get your protein in and you should do just fine.

<Tiffany> how large is the pouch that you create in RNY and how much will it stretch after surgery

<Dr.Simpson> One ounce at surgery and up to ten ounces normally -- after surgery, although you can stretch it more by constantly challenging it with more and more food, so don't do that.

<mngirl> I have a question? I have been having alot of headaches, could be that my sugars are low.

<Dr.Simpson> No, not at all. You can always check your sugar, but it is probably because you have no aspirin. Kind of like when I go home I hand the wife a bottle of aspirin and she says, " I don't need those." So I say, "Great, lets go to bed."

<Tabitha> How will this surgery affect the fetus after someone has become pregnant?

<Dr.Simpson> It won't. You need to get in your nutrition, and vitamins, but that is not a problem and the fetus will be just fine. Ten toes on the fetus.

<Moderator> Last question of the evening goes to...

<Angela> I am 2 months post op, have knee lap last year, when I increase my walking my knee hurts. Does it matter how fast you walk. I went back to work 5 days post op. No problems. I walk alot, even after surgery. I went home in two days.

<Dr.Simpson> Sounds like you need to see someone about your knee ---- and consider low impact exercise, like walking in a swimming pool, or bike riding or a rowing machine.

<Dr.Simpson> Thank you everyone for a nice chat and I hope to see you all at the event in Phoenix. www.obesitydr.com for the books. Good night.

<Moderator> Dr. Terry Simpson, Arizona Bariatric Center. Website: http://www.drsimpson.com/ . Phone: 602-234-8995 Fax: 602-230-8344. Thank you very much, Dr. Simpson. We enjoy your chats every week. We all thank you and have a great weekend.